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Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study.

TitleLower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study.
Publication TypeJournal Article
Year of Publication2002
AuthorsLiao D, Carnethon M, Evans GW, Cascio WE, Heiss G
JournalDiabetes
Volume51
Issue12
Pagination3524-31
Date Published2002 Dec
ISSN0012-1797
KeywordsAutonomic Nervous System, Cause of Death, Cohort Studies, Coronary Artery Disease, Diabetes Complications, Diabetes Mellitus, Female, Glucose, Heart Conduction System, Heart Rate, Humans, Male, Middle Aged, Myocardial Infarction, Proportional Hazards Models, Severity of Illness Index, Time Factors
Abstract

The objective of this study was to test prospectively in a population sample whether individuals with impaired heart rate variability (HRV) are at increased risk of developing coronary heart disease (CHD) and of non-CHD mortality and to test whether this relationship is more pronounced among individuals with diabetes. We examined the association between HRV and incident CHD and non-CHD mortality in a cohort of 11,654 men and women aged 45-64 years at intake, from the biracial, population-based Atherosclerosis Risk in Communities Study. Supine, resting, 2-min beat-to-beat heart rate data were collected at the baseline examination. High frequency (HF; 0.15-0.40 Hz) and low frequency (LF; 0.04-0.15 Hz) spectral powers, LF/HF ratio, normalized HF and LF, the standard deviation of all normal R-R intervals (SDNN), and the mean of the sum of the squared differences between adjacent normal R-R intervals (MSSD) were used as the conventional indexes of HRV to measure cardiac autonomic control. From this cohort, 635 cases of incident CHD (including 346 cases of incident myocardial infarction [MI] and 82 cases of fatal CHD), and 623 non-CHD deaths were identified and validated after an average of 8 years of follow-up. Among individuals with diabetes, the multivariable adjusted proportional hazards ratios (95% CI) were 2.03 (1.28-3.23), 1.60 (1.12-2.27), 1.50 (0.65-3.42), and 1.27 (0.84-1.91) for incident MI, incident CHD, fatal CHD, and non-CHD deaths, respectively, comparing the lowest quartile to the upper most three quartiles of HF. A similar pattern of associations was found for LF, SDNN, and MSSD. By contrast, there was no consistent pattern of associations among individuals without diabetes. At the population level, a lower HRV (reflective of impaired cardiac autonomic control) is statistically significantly related to the development of CHD among individuals with diabetes, independent of markers of the duration/severity of the glucose metabolism impairment. These data suggest a contribution of an impaired cardiac autonomic control to the risk of CHD among individuals with diabetes.

DOI10.2337/diabetes.51.12.3524
Alternate JournalDiabetes
PubMed ID12453910
Grant List5R01 HL 55669 / HL / NHLBI NIH HHS / United States
N01 HC 55015 / HC / NHLBI NIH HHS / United States
N01 HC 55016 / HC / NHLBI NIH HHS / United States
N01 HC 55018 / HC / NHLBI NIH HHS / United States
N01 HC 55019 / HC / NHLBI NIH HHS / United States
N01 HC 55020 / HC / NHLBI NIH HHS / United States
N01 HC 55021 / HC / NHLBI NIH HHS / United States
N01 HC 55022 / HC / NHLBI NIH HHS / United States